SHIVA GUPTA Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****64

License Status

NOT RENEWED

Business

First Name

SHIVA

Last Name

GUPTA

Business Name

SHIVA GUPTA

Original Issue Date

07/18/2000

Effective Date

05/27/2011

Expiration Date

07/31/2014

City

LONG GROVE

State

Zip

60047

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014